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Different ways to treat chronic and breakthrough pain

Treating chronic pain

Drugs used to treat chronic or persistent pain need to work for a long time. They’re called long-acting or extended-release drugs and are taken at regular times. They’re slowly released into the body and keep pain at a lower level over a long period of time.

You take these pain medicines on a schedule – even if you’re not having pain at the time the medicine is due. By taking these drugs on a schedule, you can maintain a fairly constant level of pain relief through the day and night. These drugs may be given in the form of tablets or capsules taken every 8 to 12 hours or as a skin patch that’s worn for several days. Again, these drugs are taken on a schedule and not just when you’re in pain.

Treating breakthrough pain

Breakthrough pain is best treated with pain medicines that work quickly and for a short period of time. They’re usually taken as needed, which means that they should be taken as soon as you notice breakthrough pain. These short-acting drugs (sometimes called rescue medicines) work faster than those used for chronic pain. They also stay in your body for a shorter time and tend to cause fewer side effects.

You should take your short-acting medicine when you first notice pain, so that it can start to work to relieve your pain right away. Do not let the pain build up and become too severe – it will be much harder to get under control. Follow the directions given to you. If the usual dose doesn’t relieve your breakthrough pain, or if you think you’re having breakthrough pain too often, tell your cancer care team. They may need to adjust the dose or frequency of the medicine you take for chronic pain.

You may want to take a dose of your breakthrough medicine to prevent pain before it starts if you know that you’re likely to have breakthrough pain during or after a certain activity.

Common questions about breakthrough pain

If I have breakthrough pain, does it mean that the pain medicine I’m using regularly for my chronic pain isn’t working?

No. Breakthrough pain is an intense flare-up of pain that’s usually more severe than chronic pain. Remember, breakthrough pain is common in people with cancer pain. It can happen even when a person is taking the right dose of pain medicine on a regular schedule for their chronic pain.

Still, let your cancer care team know if you’re having more breakthrough flare-ups than usual, and just how often you need your breakthrough medicine. You may need a larger dose of your chronic pain medicine.

How can I be sure that I’m getting the right dose of breakthrough pain medicine?

Your breakthrough pain medicine should relieve most of your breakthrough pain without causing unacceptable side effects, such as extreme drowsiness. If your breakthrough pain medicine doesn’t relieve the breakthrough pain or if you have breakthrough pain more than 4 times a day, contact your cancer care team. They may need to adjust your dose or type of pain medicines to help you get the best pain relief.

Can I take my chronic pain medicine and my breakthrough pain medicine at the same time?

Yes, if you need to. You may have breakthrough pain just before or after taking your regular (chronic) pain medicine. At such times, you should take your breakthrough pain medicine and keep taking your chronic pain medicine on schedule. Always follow the directions given to you by your cancer care team.

If you notice that you often have breakthrough pain right before your usual dose of chronic pain medicine, talk to your team. They may need to adjust the dose, timing, or frequency of your chronic pain medicine. If you have any questions about when to take either your chronic or breakthrough pain medicines, contact your team to discuss your pain medicine schedule.

What if I need a different pain medicine?

If one medicine or treatment doesn’t work, there’s almost always another one that can be tried. If the schedule or way that you’re taking medicine doesn’t work for you, it can be changed, too. Some pain medicines cost more than others, and this may also be an issue. Talk to your cancer care team about finding the pain medicine and/or method that works best for you.

You may need a different pain medicine, a combination of pain medicines, or a change in the dose or timing of your pain medicines if:

Your pain is not relieved.

Your pain medicine doesn’t start working within the time your doctor said it would.

Your pain medicine doesn’t work for the length of time your doctor said it would.

You have breakthrough pain more than 4 times a day, it’s getting worse, or it’s not relieved with the short-acting medicine you’re taking for it.

You have side effects. Side effects such as sleepiness, nausea, and itching usually go away as your body adjusts to the medicine. Let your cancer care team know if these bother you.

You have serious side effects such as trouble breathing, dizziness, and/or rashes. Call your cancer care team right away if any of these start.

The schedule or the way you’re taking the medicine doesn’t work for you.

Pain interferes with your normal activities, such as eating, sleeping, working, and sex.

To help make the most of your pain control plan:

Take your pain medicine on a regular schedule (around the clock) to help control chronic pain. Take it when it’s time to take it – even if you’re not having pain.

Do not skip doses of your scheduled medicine. The more pain you have, the harder it is to control.

If you have breakthrough pain, use your short-acting medicine as instructed. Don’t wait for the pain to get worse – if you do, it can be harder to control.

Be sure only one doctor prescribes your pain medicine. If another doctor changes your medicine, the two doctors should discuss your treatment with each other.

Don’t run out of pain medicine. Remember that prescriptions are needed for opioid pain medicines – they can’t be called in and drugstores don’t always have them in stock. It can take a few days to get the medicine, so give yourself time for delays.